BROOD Dog Intake Report

This Dog Intake Report is to be used by the person who physically accepts this dog in to BROOD and should be submitted online.

Note that Foster Families should fill out a Foster Dog Report rather than this form.
Dogs name? *
Originating Shelter Name *
Originating Shelter Street Address *
Originating Shelter City *
Originating Shelter State *
Originating Shelter Zip *
Originating Shelter Phone *
Please check the breed description that best applies *
Dogs age group? *
Dogs gender? * Male
Female
Previously altered? * Yes
No
Unknown
Primary color * Brown
Black
White
Red
Other (describe below)
If OTHER, please specify
Secondary color Brown
Black
White
Red
Other (describe below)
If OTHER, please specify
Pattern: * Tri-Color
Red & White
Other (use only for mixes)
If OTHER, please specify
Known bite record? * Yes
No
Known aggression issues? * Yes (describe below)
No
If YES, please explain aggression issues
Other comments
Where is the dog currently located? *
Will the dog be moving to another location? * Yes
No
Not Sure
If YES, name the location and travel date
Intake Volunteer Name *
E-mail Address *
Phone *
Verification Code:
Enter Verification Code: *
    
* Required Responses

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